Provider Demographics
NPI:1184789315
Name:SIMPSON, THOMAS ALVIN JR (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALVIN
Last Name:SIMPSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:255 W 5TH ST SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2817
Practice Address - Country:US
Practice Address - Phone:706-295-3855
Practice Address - Fax:706-235-5875
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034949207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000482996SMedicaid
C74106Medicare UPIN
GA000482996SMedicaid